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May 7, 2008

Killer Gay Sex!

by Tony Valenzuela

Barebacking Redux

A red screen flashes a statistic: 25 percent of men with HIV don’t even know they’re positive. “Come over here. We need to talk,” says a gravelly voice that you recognize immediately as the no-nonsense tone of Whoopi Goldberg. She appears in her famous shaded spectacles and an incredulous posture. “You think barebacking is cool? Are you kidding me?” she exclaims standing in front of a red, in-studio backdrop covered with various-size words and phrases such as healthy, honesty and self-respect. She continues, “We can stop HIV transmission. A condom says, ‘I love myself.’ Talking about HIV says, ‘I respect you.’ Love and respect, baby. That’s cool.” Whoopi along with Susan Sarandon, Rosie Perez and Amanda Peet each deliver two different 30-second public service announcements that ran in New York City in 2006 with overlapping messages about HIV, unprotected sex, crystal meth and self-love. For example, Rosie Perez asks us, “Condom? No Condom? Is that a question?”

In fact, it is among the most germane questions concerning gay men’s health whose elusive answer has mountains of research dedicated to it even if here the question is asked glibly by a straight celebrity. On an online gay men’s health discussion group to which I belong, these ads were fiercely debated. One man posted, “Well, I know a few of them in fact have barebacked and have the progeny to prove it. So it is especially irritating that there seems to be no room for gay men to make a thoughtful decision not to use condoms...Whoopi has unsafe sex and she gets a baby shower. I do it and I am a psychopath.” And herein lies the problem: No such words as thoughtful and unprotected dare enter the U.S. HIV prevention lexicon in the same sentence. This man’s reaction illustrates the crux of the protracted debate activists have had for a decade over sex and HIV that the New York Patient brought, once again, to a boiling point.

Over the years, the dialogue around unprotected sex has evolved as researchers have made it a favorite subject of study, so that what was initially seen as fringe behavior has been largely reframed as a problem, albeit a common one, of mental health. This work has produced a constellation of psychological syndromes, afflictions, deficits or social miasma to explain sex without condoms: low self-esteem, survivor’s guilt, loneliness, drugs, alcohol, lust, condom fatigue, AIDS fatigue, depression, sex addiction, poverty, slipping up, homophobia, internalized homophobia, racism, invincibility, complacency, because it feels better, childhood sexual abuse, self-destructiveness, sexual compulsiveness, denial, lack of education, resignation, love and the list goes on. Yet the primary reasons both HIV-positive and HIV-negative gay men give for having unprotected sex is to feel greater physical pleasure and to feel more emotionally connected with their partners—the same reasons straight people bareback. Far less frequently men cite a dislike of condoms, being high on drugs or alcohol or to do something taboo. Despite the formidable challenges gay men face in their lives, more often than not we embody a tremendous range of responses, strategies and successes. At the end of the day this is our story, not the list of deficiencies that have reduced us to a pre-Stonewall, pre-feminist notion of the patient under the omniscient gaze of the doctor.

I won’t resolve here the different points of view over barebacking, intentional unprotected sex, natural sex, raw sex—whatever you want to call it. I don’t believe there is a resolution. It is a subject deeply entangled in the normalizing politics of gay assimilation, in personal histories of grief and fear, in individuals’ boundaries of safety, in their sexual ethics and sense of morality that is formed by the minutiae of experience, politics, culture, emotion, that make us who we are.

To say the least, it is challenging to speak sensibly about gay sex, especially in the United States, when one is up against powerful institutions—health, media, politics – invested in determining all risk as pathological, gay men as damaged, disease as crisis, and HIV as it used to be—a virtual death sentence—instead of what it has become for people on antiretroviral meds: a chronic disease that must be managed with regular quality health care, individualized treatment and a broad range of physical, mental and, for some, spiritual health practices to help them live as close to a normal life span as possible.

People still die of AIDS. The treatments can and often do cause mild to moderate (and less often, severe) side effects, and scientists are now identifying long-term health consequences, such as increased risk for liver and cardiovascular disease. Some activists and public health officials are convinced gay men don’t know this or have forgotten or are in denial or don’t care, and the proof is their continued risk taking, in increased HIV infections, drug use, depression, loneliness, (insert here long list of deficits from above). This loop starts with sexual risk and doesn’t usually but sometimes does result in new HIV infections that are used to justify the pathologizing of gay sex, the deficits approach to our health, the use of disease as terror to curb the risk taking that doesn’t usually but sometimes … and on and on.

I suggest a way out of this all too familiar vicious circle, besides the obvious demands for universal health care and fighting poverty (two social justice issues that would do more for reducing HIV infections than all behavioral interventions combined): We must stop using HIV as the primary gauge to measure the gay well and unwell. There are other health challenges, like drug abuse, mental health, obesity and smoking, that are also harming gay men and lesbians. If HIV continues to be the barometer by which we assess the wellness of gay men—instead of one among many physical, mental and spiritual health concerns—then we are destined for generations of failed gay and bisexual men, because risk will not diminish as the consequences of it do.

During one of the last times I saw the New York Patient, late in 2007, he took me to see his painting that hangs at GMHC. “I realized something,” he told me on our way there. “I was looking at all the drawings and paintings I’ve done since I joined the art workshop. I used to sign my paintings with my name followed by the initials SV for supervirus. I stopped doing this in the middle of last year and didn’t even realize it.”

The supervirus has been put to rest.

We’ve stayed in touch by phone, grabbing lunch when I’m in New York or sometimes by quick e-mails to tell me how he’s doing. “I have visited three high schools this year on HIV prevention talks!!!” he wrote recently. “It feels GREAT talking to these young students, especially since they are such a high target of newly diagnosed these days.” He’s been dating here and there, he told me, and his health has been good. He has been off the Fuzeon injections for a few months, and the Isentress appears to be working. His injection-site sores have all but gone away, leaving a few scars on his legs and stomach. His last CD4 count was 292, and his viral load remains undetectable. “I’m getting closer to feeling as well as before HIV,” he told me during one recent phone conversation. “I’m slowly getting my life back. Hopefully I’ll get back to work sometime soon.”

Considering all he’s been through—all we’ve been through—this is news worth celebrating.

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Michael, Haslett, 2008-05-08 13:50:01
I think it is so terrible because even our leaders are the same way, they think about two men together having sex a terrible things, but if it is two women together they think it is neat. Why is it that men have to be treated so differently when it is known that they have sex with other men.